Provider Demographics
NPI:1881717742
Name:RODRIGUEZ, CARMEN HILDA
Entity type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:HILDA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BERGEN TPKE
Mailing Address - Street 2:APT. 2P
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-2336
Mailing Address - Country:US
Mailing Address - Phone:201-814-1723
Mailing Address - Fax:201-814-1723
Practice Address - Street 1:100 N PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-2005
Practice Address - Country:US
Practice Address - Phone:718-260-4814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP50793104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker